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FOR OFFICE USE -[�-- ---- -- 5-_------------------2 -- APPLICATION FOR SANITATION PERMIT Permit No. __1.!_._1t .5__ -------------------------------------------------------- (Complete in Duplicate) --------- __-_..--------------------------..___...__..__ This Permit Expires f Y-ear.IArom Date Issued Date Issued -___ _ �o Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---------J�-----cZ----------------- ------=---------- - - - - ---- ----------- � '_81 9 Owner's Name _ Jj Phone -------------- - ----�/ S C� �,•�----- �c ------------------------------- - ----------- ---------------------------.......--------------------------------- Contractor's Name. �/G�- 3/yz_ ------------------------ ----------------- ------------------------------------------- Phone--- - - Installation will serve: Residence [9---A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms t Number of baths Lot size ----40-- - r _.1 _�_________._ _ ---------- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table �/ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 29-'Hardpan ❑ Previous Application Made: {If yes,date--------------------1 No ❑ New Construction-, Yes g?—'�o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pti iTn Distance from nearest well_________________Distance from foundation___----_-------- Material-------cbx.C�L[-(.�_----------------- No. of compartments------ ------------ -- --Size--------------------------------Liquid depth--------------------------Capacity---- ------- Disposd: Distance from nearest weII )1-61 Distance from foundation__/0_____....Distance to nearest lot line----S.__------ Number of lines--------- --------!$'- �-�} ---Length of each line------- a- ----;`...Width of french--------Z_y--�-- Type of filter material '-v c ---Depth of filter material------ _------.Total length--------------------'rrIC_ ------------- Seepage Pit: Distance to nearest wel014KA-----Distanc m founda#ion____/a--------Distance to nearest lot line-----S_---_--- '1 p ------------Lining material_ 0 ----Size: Diameter_----- -3_00' ---Depth...._.__ -��------------N Number of its_--_--_ _ Cesspool: Distance from nearest well-----------------Distance from foundation_...----------------Lining material-------- ------ ------------`_.------. ❑ Size: Diameter-------------------------- ----= -----Depth-------=;-=-----------------------------------------Liquid Capacity- -------------------------gals. m Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_----------------------------------------- 0 _-----__._----._---.--_____--__--°_....❑ Distance to nearest lot line------------------------------------ ---------------------------- Remo eling and/or repairinq.4de r ---------------- --------- ---------------------------------------------------------------------------------------------------------------------- --------------------------------- -- -------------- - -- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. t (Signed)--- ------ --- -F - - --- ------------- ---------- -------- - -- ---- - ------- (Owner and/or Contractor) ------------------- --- ----------- ----------- -- RY: ------------ --- -------------- - ----, --------------------------{Title �/= - - `� - (Plot plan, showing size of lot, location of system in relatiofi to wells, buildings, etc., can be placed n feverse side). ,� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ — '------------------------- ------ ---------------------------------------- DATE----------- ~ ✓-- -` L--=f --------- REVIEWEDBY------------------------- ---------------------W----------------------------------------------- ------------------------------ DATE------- BUILDING PERMITISSUED------------------------------------------------------ ------------------------------ DATE.------------------------:--------- ---- Alterations and/or recommendations:.-_S _ .. . ._-a� ____. _-_." ----------------- "- __�__________ _ R' -------------- ---- -Q- = ------ - - -------------------------------------------- C��Z--------------------------------------------------- --------------- --------------------------- -----•-------------------------------- ------ ---------------------------- ------------------------------------- ------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:- ------ ----------------------------------------- Date----.... —T �-s --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.